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senior fit

The Case for Fitness & Healthy Aging

/11 November 2021/ All MFN blog/

An important principle that has emerged throughout my writing on “healthy aging” has been the issue of fitness and the role being fit plays in preventing illness and injury, yielding a fulfilling and vibrant life – a “life well lived”. The point of healthy aging is to be in a position as we grow older “to do what we want when we want without getting hurt”. I have always believed that my level of fitness would yield positive results as I got older emotionally, physically, mentally and spiritually – and so far I have been proven right in my own life. The “fitness lifestyle” is a consciousness issue just as healthy aging is as well. I make choices everyday that are designed to enhance my ability to live the way I choose. This always includes high intensity, focused training which will (hopefully) prepare me for the challenging years ahead.

Speaking, traveling, teaching, program design, consulting, writing and other activities that I wish to do in my future will require focus, high energy, inspiration, imagination, and physical stamina and endurance. The ability to train the way I am now will translate into the future actions that will yield the result I envision for audiences in the years ahead. Planning for a future that requires me to be prepared to do my work at a high level will also demand that I be as fit as I can be in order to give me the strength to help as many people as I possibly can – while I can. This is my mission – and my purpose.

This article is about something I think about EVERY day. Each of my actions, decisions, and thoughts are applied to the outcome that I seek with every step I take in becoming stronger, faster, quicker, more powerful, balanced, imaginative, flexible and skilled. My purpose is to be able to PERFORM at a high level even as I approach my 70’s and this is the point of my plan – and these articles in this series. How fit are you today for the future you envision for yourself? Does your vision inspire you to reach beyond your grasp? Does it “pull you forward” so that you will take the actions necessary to enable and empower you for the journey ahead? Only you can answer this question! Do it now!

Power, speed, quickness, strength, endurance, balance & flexibility:  the “core” of healthy aging and growing old – not old.

I think of training in terms of performance and so much of fitness today is “gimmicks” – programs designed for the “few” in America who are NOT the obese, overweight, poorly trained, seniors, and youth. The “fatting” of America does NOT include practical programming on TV, the internet – or anywhere for that matter – that appeals to the average, untrained individual struggling just to live a ‘moderately’ happy life. I see this huge “hole” in our society everyday when I go out into the world where the “connection” between being fit and “regular” people is NEVER being made. To most of the world, fitness – or becoming fit – means acquiring a gym membership with all the “hassles” that implies and THAT isn’t healthy or inspiring at ALL!

I worked in the Nautilus and Bally’s systems as a trainer for over ten years and I never once saw the effort being truly made to help people “realistically” ACHIEVE anything. The world outside the gym is a giant “blank” for over two thirds of the population. The only thing I see that is visible today is elementary lifestyle “advice” on Dr. Oz and other related sophomoric network shows that really change nothing. The other major factor in the sales “pitch” to America on fitness comes in the form of “infomercials” that literally “sucker” people into buying USELESS stuff that will never really help them – EVER! The latest gimmick is the “abdominal belt” that will ‘melt” fat away with just 10 minutes a day! This is just the latest in the same old scam – “sell them anything and make a buck in the process!” What a disgrace and a shame that we have resorted to “hucksterism” in this country in order to sell the virtues of being fit! Jack Lalanne’s legacy has almost been completely forgotten today and I want to make sure I play my role in carrying the work he started so long ago forward with me. At least he TAUGHT simple exercises to people of all ages in the 50’s and 60’s with passion AND led them every step of the way during his shows. Those days are long gone!

When we think of helping people to become fit and healthy, we must always remember to train ourselves FIRST so that we can inspire others to do the same. I will not TELL anyone anything because for each of us our understanding and perspectives are different – just as each of us is different. I will always side with “being the example of the change I wish to see in the world” – the theme of my first article in this series. How do I retain my skill level with the “seven keys” of fitness highlighted above? I maintain them – and will elevate myself to higher levels of performance in the future – through my weekly weight training program, running 40 to 50 miles a week, stretching, and meditation. This dedication to fitness will hopefully allow me to do what I want, when I want, without injury and live with joy the active future of service I am envisioning for myself. I believe that with each passing day we are ALL falling ‘behind the fitness curve’ in life – whether we are training or not – and it is imperative that we translate our passion for being fit to others through our example. If we CAN’T DO IT, WE SHOULDN’T BE TEACHING IT!

Conclusion

My primary commitment to myself each day is to NEVER GIVE UP. If I am not sick or injured, I am training – training for my life to come and the role I have chosen for myself as “an agent of change in the world”. Each of us MUST decide what it is WE STAND FOR so that others can be inspired by our example. Jack LaLanne taught me through his example – as John Wooden did – that it is WHO WE ARE on the inside that will be the ‘key’ to inspiring and encouraging others to reach beyond their current grasp and strive for more than they ever dreamed possible. I am convinced every day by what I see in the world that what we have to offer the ‘many’ is desperately needed now more than ever. If we do not take up this challenge, who will? When will the REAL change come? It will only come when we change ourselves (on the inside – healthy aging is an inside job, remember?) and that is the greatest challenge that we will ALL face in life. It is worth fighting for this principle every day of our lives. Will you take it upon yourself TODAY and join me in this “journey of change” – and touch millions of lives in the process? I hope your answer is a resounding YES!

Article reprinted with permission from Nicholas Prukop. 

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose passion for health and fitness comes from his boyhood in Hawaii where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

Stressed Man Working At Desk In Busy Creative Office

5 Surprising Ways That Your Job Influences Your Health

/5 November 2021/ All MFN blog/

Different aspects of your life can affect your health. Exercise, food intake, and sleep are prevalent factors. Unknowingly, your job also affects your mental and physical health. You must consider it if you wish to live a healthy lifestyle.

You spend a majority of your waking hours at work. Several studies have pointed out that the work environment affects your overall well-being and relationships with other people. Let’s take a look at some of them:

Work Overload

Overworking can have adverse effects that include mood disorders, debilitating stress, and illness. If you have little control over your workload, you may experience burnout. According to the American Institute of Stress, 80% of employees and managers face stress at work that results from competition between coworkers, tense working environments, and a feeling of walking on eggshells.

The World Health Organization describes burnout as a type of chronic work stress depleting energy and diminishing efficacy. 50% of workers quit their jobs because of it. You tend to mentally disengage from your coworkers and become increasingly adverse about them. Cynicism with extended working hours drains your joy about working and increases exhaustion.

Depression and anxiety are also prevalent when you overwork yourself. Your moodiness can affect your relationships with your colleagues and supervisors. Overworking can also increase overall work dissatisfaction and heighten anxiety, and you also experience low self-esteem and have feelings of inadequacy. Your feelings of helplessness and restlessness can make you slip into depression.

Lack of Physical Activity

If you work in an office setup, your lack of physical activity can result in several health problems. Your sedentary lifestyle can lead to muscle-related pain, fatigue, and diabetes. You are also susceptible to eye issues if you stay glued to your computer every day.

You often get lost in work and spend hours in your seat. If you suffer from constant backache, you now know why. Sitting in your office chair for extended periods can strain and overstretch your back muscles.

Hating Your Job

If you love your work, you are fortunate because you can pay your bills doing things you like to do. Unfortunately, if you hate what you do but stay in your job to pay the bills, you become unhappy and eventually suffer from stress and exhaustion.

The University of Manchester released the results of its study about poor-quality jobs. According to them, staying in a job you have can wreak havoc on your mental health. It is even worse than being jobless. A passive-aggressive boss, hostile co-employees, and mind-numbing tasks, together with spending more than 40 hours per week in your office, can worsen your situation.

If you are dealing with a mental health issue, you can experience stress, burnout, and exhaustion, especially if you cannot find other jobs or feel obligated to stay because you have bills to pay. Your loss of autonomy and feeling of indebtedness can be emotionally draining.

You feel stuck because your mental health issues do not allow you to find your way out. You do not have the motivation to search for alternatives. You feel helpless and hopeless to change your situation. Getting out of the trapped mindset needs a courageous effort.

Long Commute

The workday starts and ends with your commute. If you live in a large city, your commute takes longer. You become less happy and experience burnout quicker. Your daily commute is also a health risk as commute distance and time continually increase. As a commuter, you spend more than a total of 80 minutes getting to and from work.

The situation worsens if you must commute from one city to another. It increases your blood pressure. You experience heightened cortisol and adrenaline levels that raise your risk of a heart attack. Respiratory issues and air pollution exposure can also have acute effects on your health.

If you stay in your car for an hour’s drive to work, you are adding one more hour to your sedentary lifestyle. Lack of physical activity can lead to diabetes and obesity. Aside from the physical manifestations, an extended commute can also lead to listlessness, boredom, anger, and stress.

Although you can deal with them, you suffer from long-term chronic stress if such moments occur daily. Driving through traffic can result in expending more mental and physical energies that can be exhausting.

Interpersonal Relationships at Work

Establishing close connections with your coworkers is healthy. You are less likely to feel burnout and become happier if you have more camaraderie with your colleagues. Belonging to a group increases your sense of purpose, meaning, affinity, agency, and control. You become competent and productive at work because of your identification with your company.

However, if you have negative work interactions or experience bad bosses and bullying, your health can suffer. Loneliness can result in your untimely demise. Therefore, you must connect with other people in your company. If you can find connectivity with your bosses or coworkers, you can search elsewhere.

 

bone-health-question-osteoporosis

Osteoporosis: A quick primer for everyone over 50

/3 November 2021/ All MFN blog/

When you think about staying healthy with age, your bones may not be at the top of your concerns.  Age-related bone loss is not generally as obvious as changes in other areas such as our vision or our muscle strength. But a staggering 40% of Americans over age 50 have low bone density, and many people don’t realize they have a problem until they actually break a bone.  This will happen to over half of women over age 50 at least once in their lifetime.  And despite the common assumption that men don’t need to worry about osteoporosis, a quarter of men over age 50 will suffer an osteoporosis-related break in their lifetime as well.  In fact, men are more likely to suffer a fracture from osteoporosis than they are to get prostate cancer.  

Bone fractures after age 50 can be serious and disabling.  And with a quarter of all hip fractures in people over 50 resulting in death within one year, bone health should be a serious concern for everyone as we grow older.1

So what happens to our bones as we age, and what steps can we take keep our bones healthy?

Bone density changes with age

We often think of bones as hard and lifeless, but they are actually living and changing structures that are constantly reforming and recycling themselves, taking away old minerals and replacing them with new minerals.  Calcium and magnesium play a key role in the growth and formation of bone, helping us achieve peak bone mass between the ages of 18 and 30. The more bone you have at the time of peak bone mass, the less likely you are to break a bone or get osteoporosis later in life.  After you reach peak bone mass, the balance between bone formation and bone loss might start to change.  You may start to slowly lose more bone than you form. In midlife, bone loss usually speeds up in both men and women. For most women, bone loss increases after menopause, when estrogen levels drop sharply.  In fact, in the five to seven years after menopause, women can lose up to 20 percent or more of their bone density.  The result is that bone becomes weaker and more fragile, and more likely to break from even minor impacts.  

How you can help keep bones healthy

Eating a healthy and varied diet with adequate vitamin D3, calcium and magnesium for bone formation is essential.  You can find recommendations for your age and gender on the National Osteoporosis Foundation’s website (nof.org).  

Exercise is also critical.  Strength training to keep muscles strong can help limit falls, which in turn can help prevent resulting fractures.  Current exercise recommendations are to do at least 15-30 minutes daily of high impact, weight bearing exercises such as dancing, hiking, jogging/running, jumping rope, stair climbing or tennis.  Low-impact weight-bearing exercises can also help keep muscles strong and are a good alternative if you can’t do high-impact. 

Smoking and alcohol also impact bone health.  Avoid smoking and limit alcohol intake to less than three drinks a day.  

Talk to your doctor

There are many additional risk factors for osteoporosis, such as ethnicity, diseases such as rheumatoid arthritis, and medicines you may be taking.  So it’s important to discuss your risk with your primary care physician BEFORE you have a fracture.  If warranted, your doctor may recommend a test called a bone density study or DXA scan.  If you are diagnosed with osteoporosis or osteopenia (a condition of low bone density pre-osteoporosis), your physician may recommend changes to your diet, supplementation, and possibly medications. 

For more information to help you take charge of your bone health, check out the National Osteoporosis Foundation at www.nof.org.  

Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis.  

References

senior-couple-walking

Key Exercises and Training for Aging Successfully and Living Your Best Life

/14 October 2021/ All MFN blog/

As the years roll by, nothing has become clearer to me than the fact that aging successfully requires a lot of work. When it comes to our bodies, nothing rings truer than, “If you don’t use it, you lose it.” This is particularly true not only when it comes to preventing declines arising from disuse, but also when trying to slow down the normal impacts of aging. 

The function of our bodily systems peaks at around age 25 and declines over time. As a result, your maximal aerobic capacity decreases, even with constant training, reflective of declines in maximal heart rate. In addition, your balance ability gets worse (particularly after age 40), bones get thinner, muscles atrophy, reflexes get slower, and recovery from workouts takes longer. Aging is not for sissies, but it beats the alternative!

The good news is that it is possible to slow the rapid decline of these systems by changing how you live your life. By including regular physical training, better nutrition, adequate sleep, and stress management, you can delay or prevent a lot of normal aging and reverse decrements caused by inactivity, neglect, disuse, and abuse of our bodies. The only caveat is that we can’t control or reverse neurological decline.

It starts to seem like preventing additional declines from inactivity or inadequate training gets to be a full-time job as you get older and you have to keep adding in additional exercises, stretches, and activities. A fitness instructor recently confirmed that it’s a bit like playing whack-a-mole: fix one weak area or physical problem and another one pops up. Welcome to aging!

So what can you do to live your best life both physically and mentally? I would suggest adding at least these (and many other) critical exercises to your weekly routine:

Cardiorespiratory fitness: Cardio workouts with faster training intervals

In addition to doing regular cardio activities like walking, cycling, and swimming, add in some faster intervals into any workout, such as walking faster for 10 to 60 seconds at a time during your normal walk or doing a hill profile on a cardio training machine. Doing so will increase your fitness more and improve insulin sensitivity for longer. It’s also fine to do high-intensity interval training (HIIT) at least once a week, but start out slowly and progress slowly to prevent injuries and demotivation. Not all your workouts should be equally intense, and varying your aerobic activities also lowers the risk of getting injured.

Muscular strength and endurance: Resistance training exercises

It is easy to work on your muscle strength and muscle endurance by doing a series of resistance exercises targeting your major muscle groups (in the upper body, lower body, and core areas). Pick at least 8 to 10 exercises that cover all these areas and do them at least two to three days per week. It’s fine to use your own body weight, household items (like full water bottles), hand weights, or resistance bands as resistance—you don’t have to have access to a gym or leave home. Adding in these exercises to your weekly routine is critical to aging well and being able to live independently throughout your entire lifespan.

Balance ability: Standing on one leg at a time (and other balance exercises)

This simple exercise involves standing on one leg for a minute, switching to the other leg, and repeating. Have something you can grab onto nearby, such as the back of a chair. You can hold on with both hands, one hand, one finger, or nothing as you get better at balancing. To challenge yourself, move your free leg in different directions (e.g., out front, to the side, behind you) while standing on the other one, or practice standing on uneven surfaces, such as a cushion. If your balance ability is really getting to be an issue, include other balance training activities each week as well.

Joint mobility and cartilage health: Stretches for all your joints

Do a series of flexibility exercises that stretch your joints in all their normal directions to maintain and increase their range of motion. With aging, we are all losing flexibility and diabetes can accelerate this loss when extra glucose sticks to joint surfaces (cartilage) over time and makes them more brittle. Try to stretch at least two to three days per week. The older you get, the longer you should hold each stretch (up to a minute on each one), and you may need to add in specialized stretches (such as for your calves or hips) to really work tighter joints to enhance your mobility and balance ability.

Bone strength: Weight-bearing activities and/or resistance training exercises

Your bones stay stronger when you put normal stress on them regularly, such as carrying your own body weight around when walking or jogging or doing resistance exercises with your upper body or carrying grocery bags. If you stay sedentary, your bones will lose minerals faster and get thinned out more quickly, and non-weight-bearing activities like swimming and cycling just don’t have the ability to build bone as much as weight-bearing ones. Try to adequately stress your bones to stimulate the bone mineral density to stay higher—at least two to three days per week.

Basic mobility and self-care: Wall sits and/or sit-to-stand exercise

Until you start to get older, you seldom think about how difficult it can be to get up out of a chair or off the sofa. Many older people get heavier and weaker and start to have trouble doing these basic maneuvers, which are critical to living well independently. To improve your ability, practice doing wall sits, which involves sitting against a wall with your hips and knees at 90 degree angles and your feet straight below your knees for as long as you can. This exercise will also help prevent knee pain and problems. Alternatively, you can do sit-to-stand exercises where you sit on the edge of an armless chair and practice getting up without using your arms. (This is also often called the “getting up from the toilet” exercise.)

Sexual enjoyment (and incontinence): Kegel exercises

Also known as pelvic floor muscle training, Kegel exercises can help with stress incontinence (i.e., urinating a little when sneezing or laughing) and normal incontinence (both urinary or fecal), and they may enhance your sexual pleasure to boot. The easiest way to identify the pelvic floor muscles is to stop your urine flow while urinating or tighten the muscles that keep you from passing gas. To do Kegels, imagine you are sitting on a marble and pretend you’re lifting it up by tightening your pelvic muscles and holding them contracted for as long as you can; do this a few times in a row. When your muscles get stronger, you can do these exercises while sitting, standing, or walking. Both men and women can and should do Kegel exercises regularly.

Sheri R. Colberg, PhD, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook). She is also the author of Diabetes & Keeping Fit for Dummies, co-published by Wiley and the ADA. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 34 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

female-trainer-senior-client-exercise-ball

Flip the Script: How Fitness Professionals Can Overcome Challenging Clients

/24 September 2021/ All MFN blog/

If you are a fitness or medical fitness professional, there is a good chance you have heard one or more of the following statements at least once in your career. In fact, there is also a good chance you have heard these statements on a daily basis. 

1. I am a little tired and my muscles are a little sore from our last session, so I am going to cancel today and rest. 

2. I don’t want to do “that exercise” because I have never done it before.

3. My doctor told me that I should not be squatting, bending, reaching, twisting, etc… 

Many of you reading this article can relate to at least one of the above and may have even let out a slight sigh of frustration when it comes to overcoming challenging clients. Overwhelming amounts of research show that exercise can help to improve your health and fitness without hurting your joints.(1) With your current treatment program, exercise can: 

  • Strengthen the muscles around your joints 
  • Help you maintain bone strength 
  • Give you more energy to get through the day 
  • Make it easier to get a good night’s sleep 
  • Help you control your weight 
  • Enhance your quality of life 
  • Improve your balance 

However, many of our clients still believe that exercise will aggravate their joint pain and stiffness, but that is not the case. Lack of exercise actually can make your joints even more painful and stiff.(2) If the muscles and surrounding tissue are strong, it helps to maintain support for your bones. Choosing not to exercise weakens those supporting muscles, creating more stress on your joints. 

While fitness and medical fitness professionals understand the importance of exercise, the way we translate this to our clients is key. Oftentimes, clients receive misinformation along with mixed messages from doctors, family members, friends, and of course, social media. However, after decades of both academic and professional research working with special demographics, I have discovered a powerful technique to increase clients’ willingness to improve their health through exercise. The answer lies not only in showing the client how each exercise emulates real-life situations, but also how it affects their independence.

For example, telling a client, “Today we will be working on how to safely and effectively execute a squat,” is a lot different than saying, “Today we will be practicing our sit to stand movements so that you have the lower body strength and flexibility to rise from your favorite chair without assistance.” 

Most importantly, it is important to reiterate to your client that their lack of strength, mobility, and balance leads to a more sedentary lifestyle that will decrease their ability to function independently as time progresses. Additionally, muscle atrophy, joint immobility and poor flexibility are key indicators that functional movements, or movements that are required to perform everyday tasks, will soon be a thing of the past.

If a client is unwilling to perform various exercises, here are some conversation starters:

  1. Did you know that this is not just an exercise, but one of the foundational movements to support strength, balance and flexibility in your everyday life?
  2. Do you know the definition of functional fitness?
  3. Do you know that this isn’t just an exercise, but will help you walk up and down the stairs, get up from a seat, carry your groceries, and pick up a grandchild?
  4. Are you ready to give up your independence? 

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently serves as the Director of Membership for MedFit Network, sits on the MedFit Education Advisory Board and is a course author for MedFit Classroom. She is also CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation and co-host of Two Fit Crazies & A Microphone Podcast. 

Check out Christine’s online course with MedFit Classroom, Arthritis Fitness Specialist:

References

  1. CDC: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2021, April 5). Benefits of Physical Activity. Center for Disease Control and Prevention. Retrieved September 10, 2021, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Mayo Clinic. (2021). Exercising With Arthritis: Improve Your Joint Pain and Stiffness. Mayo Clinic. Retrieved September 9, 2021, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971
seniors-biking-in-gym-group

Exercise’s Impact on Cognition

/22 September 2021/ All MFN blog/

It’s not news that the brain changes with age. Significant changes in regions of the brain occur in healthy adults as they age, based on MRI studies.(1) The caudate, cerebellum, hippocampus, and association cortices shrunk substantially. This shrinkage in the hippocampus and the cerebellum accelerates with age. The hippocampus, the site for new memory formation, is involved with learning and emotion with a rich supply of estrogen and progesterone receptors. The cerebellum coordinates voluntary movements including all conscious muscular activity, balance, coordination, and speech.

Incidence of Dementia

The United States is experiencing both a declining birth rate and an increased average life span. This combination will increase the percentage of people over the age of 65 to 19.6%, resulting in a total of 71 million people by the year 2030.(2) The number of people over the age of 80 is also expected to increase to 19.5 million by 2030.(2) These changes will greatly increase the number of people with dementia since 6% to 10% of North American individuals aged 65 or older have dementia; this increases to 30% in those aged 85 or over.(3)

Dementia, or senility, is a difficult-to-define cluster of symptoms that include memory loss, loss of vocabulary, and loss of motor function in the absence of a change in the level of consciousness. Dementia can be measured qualitatively by verbal memory tests such as the Blessed Orientation-Memory-Concentration test, comprising six questions as listed in the following table:

The scores from each of the table’s six items are multiplied to produce a weighted score. Score 1 for each incorrect response; weighted error scores greater than 10 are consistent with dementia.(4)

Exercise Affects the Brain

The incidence of Alzheimer’s dementia can be used as a measurement of brain health.(5) As part of his study “Exercise Is Associated With Reduced Risk for Incident Dementia Among Persons 65 Years of Age and Older,” Eric B. Larson, MD, MPH, et al asked 1,740 mentally healthy men and women over the age of 65 how many days per week over the past year they had exercised for at least 15 minutes. The incidence of Alzheimer’s disease (AD) was significantly higher for individuals who exercised fewer than three times per week (19.7 per 1,000 person-years) compared with those who exercised more than three times per week (13 per 1,000 person-years). These results were not influenced by the E4 alleles on the apolipoprotein gene, which indicates a genetic predisposition for AD.

Laura Podewils et al studied the relationship between physical activity and dementia in 3,375 men and women over the course of 5.4 years.(6) Physical activity in these individuals over the age of 65 was assessed via the Minnesota Leisure Time Questionnaire. The subjects were questioned regarding the frequency and duration of their physical activity over the previous two weeks. Like Larson et al, this study found that increased exercise decreased the incidence of Alzheimer’s dementia.

The Mini-Mental State Exam can be used as a measure of cognitive ability or impairment. The 30-point questionnaire commonly used by health care providers screens for dementia, evaluates cognitive impairment, and follows cognitive change over time, making it an effective way to document an individual’s response to treatment.(7) Kristine Yaffe, MD, et al used the Mini-Mental State Exam to show that cognitive performance increases as the number of blocks walked per week increases.(8) The study involved 5,925 women over the age of 65 over a six- to eight-year period.

The most objective measure of cardiovascular fitness is the measurement of the maximum rate of oxygen consumption as measured during incremental exercise—milliliters of oxygen per kilogram of body mass per minute. A subjective measure of exercise amount or duration is not as accurate as the above direct measure, which is called maximum oxygen consumption or VO2 max. Deborah Barnes, PhD, et al conducted a six-year study of 349 individuals over the age of 55 measuring both VO2 max and subjective measures of fitness. Barnes found only the lower levels of VO2 max correlated with cognitive decline.(9) The four studies mentioned show a positive cognitive benefit from exercise. A meta-analysis performed by Colcombe and Kramer from 1966 to 2001 examined 18 studies of fitness training and cognitive function in nondemented older adults. They concluded that fitness training had a positive influence on cognition.(10)

Prospective controlled human studies provide more robust data than both animal and uncontrolled studies. Stanley J. Colcombe et al were the first to show in a prospective controlled setting that increases in cardiovascular fitness in humans results in increased functioning of the prefrontal and parietal cortices. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain and may serve to reduce both biological and cognitive senescence in humans.(11) In addition, women tended to exhibit the greater benefit.(12) In a literature review, Kramer et al complemented these data through the use of MRI, which is very accurate in the brain. Through this technique, Kramer and colleagues concluded that older adults who participated in the aerobic training group demonstrated a significant increase in gray matter volume in regions of the frontal and superior temporal lobe when compared with controls. The results suggest that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.(12)

Animal studies offer some insight into how aerobic exercise benefits brain function. Aerobic exercise increases brain function in both young and old animals. Aerobic exercise increases the levels of brain-derived neurogenic factor (BDNF) and insulinlike growth factor 1 (IGF-1). BDNF has been shown to regulate neurotransmitters, including dopaminergic and cholinergic systems and may be playing an important role in the exercise-induced effects on the brain.(13) BDNF may be involved in the postexercise changes seen on a brain MRI. In addition, IGF-1 may be mediating the effects of exercise on BDNF, neurogenesis, and cognitive performance. Animal studies provide information on the effects of exercise that is difficult to obtain in human intervention studies. The sum of these animal studies overlaps with results from human studies and suggests that exercise is an effective enhancer of neurocognitive functioning in both young and old animals.(12)

AD, the most common form of dementia, shares many age-related pathophysiological features of type 2 diabetes, including insulin resistance, disrupted glucose metabolism in nonneural tissues, peripheral oxidative and inflammatory stress, amyloid aggregation, neural atrophy, and cognitive decline. Brain insulin resistance appears to be an early and common feature of AD, a phenomenon accompanied by IGF-1 resistance, promoting cognitive decline independent of classic AD pathology.(14) Such a large set of shared features suggests shared etiologies.

Recommendation

High-intensity interval training (HIIT) is a type of endurance training involving short periods of maximal effort followed by periods of maintenance or recovery effort. What can differ is the timing and type of endurance exercise. A typical cycling HIIT pattern may be four to six maximal 30-second cycling sprints separated by 4.5-minute recovery periods of comfortable cycling. When HIIT is compared with longer steady endurance training, the HIIT patterns show increased mitochondrial density in muscle cells and greater muscle performance improvements.(15,16)

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This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

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This article was featured in the Jan/Feb 2016 issue of Today’s Geriatric Medicine (Vol. 9 No. 1 P. 26). Written by Robert Drapkin, MD

Robert Drapkin, MD, a medical oncologist and competitive bodybuilder in Clearwater, Florida, specializes in helping elderly adults achieve a healthful lifestyle to combat illnesses or disease and to extend lifespan.

 

References

1. Raz N, Lindenberger U, Rodrigue KM, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676-1689.

2. Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3(2):A34.

3. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3-S18.

4. The Blessed Orientation-Memory-Concentration Test. University of Missouri Geriatric Examination Tool Kit website. http://geriatrictoolkit.missouri.edu/cog/bomc.pdf.

5. Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

6. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161(7):639-651.

7. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res. 2000;13(4):209-213.

8. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.

9. Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-465.

10. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125-130.

11. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101(9):3316-3321.

12. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985). 2006;101(4):1237-1242.

13. Knüsel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88(3):961-965.

14. Talbot K, Wang HY, Kazi H, et al. Demonstrated brain insulin resistance in Alzheimer’s disease patients is associated with IGF-1 resistance, IRS-1 dysregulation, and cognitive decline. J Clin Invest. 2012;122(4):1316-1338.

15. Gibala M. Molecular responses to high-intensity interval exercise. Appl Physiol Nutr Metab. 2009;34(3):428-432.

16. Billat VL. Interval training for performance: a scientific and empirical practice. Special recommendations for middle- and long-distance running. Part I: anaerobic interval training. Sports Med. 2001;31(1):13-31.

brain-digital-image

The Neuroscience of Mind-Body

/20 September 2021/ All MFN blog/

In an era where neurological disorders and mental illness run rampant, effective and scalable non-pharmacological interventions are desperately needed. Luckily, science continues to demonstrate the efficacy of exercise-based interventions in improving cognitive, neurobiological, and mental health outcomes in a variety of populations. Multiple modalities of exercise, such as aerobic training and resistance training, continue to demonstrate improvements in several measures associated with brain health. While aerobic exercise has received a majority of the spotlight over the past couple of decades, other forms of exercise have also moved to the forefront of the exercise-neuroscience literature.

Senior-and-Trainer

How Feedback Can Improve Sit to Stand Performance

/15 September 2021/ All MFN blog/

Sit -to -stand transfers are important movements that physical therapists, occupational therapists, trainers, and coaches use every day with their clients. With professional guidance clients can successfully learn the symmetry of weight distribution and other mechanics required to correctly perform sit-to-stand. Without such guidance clients may not learn the safe and correct way to get up from a seated position or to use the movement as exercise. The result can be pain, falls and other injuries.

Feedback

Feedback regarding proper motor patterns is an important tool that can lead to greater movement efficiency, increased activity, and lower risk of injury. After analyzing the different phases of sit to stand (preparatory/ starting alignment, transitional movements, and the final standing posture), clinicians can use feedback to address both the spatial and temporal parameters of movement that is needed to improve overall performance.

Why We Need Feedback

A natural part of performing a skill is to use intrinsic feedback, the sensory perceptual information caused by-the movement. Vision, proprioception, touch, pressure, and audition help formulate a person’s internal representation of a movement goal.

When performing sit- to- stand, proprioceptors indicate the muscle length and tension of the position of the ankles and feet, as well as the amount of pressure through the limbs; visual information orients the individual to the environment; and vestibular inputs, contribute to sense of verticality. If your clients are not receiving the proper intrinsic feedback, they may not be aware of their movements. For example, an individual with impaired ankle proprioception may need extrinsic or augmented feedback to increase the weight and symmetry through their legs.

Augmented feedback enriches/enhances intrinsic feedback. It provides information to clients who are unaware of their body position. Augmented feedback can help engage the patient during all phases of sit -to- stand and with different modalities: visual, auditory or tactile.

What type of Feedback to Use? Auditory, Tactile, or Visual?

When training sit<>stand, what type of feedback and verbal cues would you provide to achieve forward weight shift, symmetry of weight distribution versus increasing speed of transfer?

Think about your clients who have trouble getting up from sitting and are not sure why they cannot rise on their first attempt. Often patients think the problem is lack of strength.

Sometimes using the cue “nose over toes” works for these patients. Other times, it is the size and timing of their forward weight shift that needs to be cued?

Auditory feedback provides an engaging solution in this situation. For example, the Step and Connect’s Balance Matters System features auditory feedback about the timing and amount of weight the client shifts forward. The system’s innovative foot pads make a clicking sound when the move is done correctly. The click is nonjudgmental and motivating. The client learns a new way to move without verbal instruction.  With practice the correct move becomes automatic.

During sit to stand transfers auditory feedback can improve: 

  • Starting alignment
  • Forward weight shift
  • Timing of weight shift
  • Symmetry of weight distribution
  • Postural control (decrease sway at the ankles)

Example using the Balance Matters system:

Sit to stand: Activate back clicker, activate front clicker while you stand, keep all clickers quiet during standing.

Stand to sit: Keep all clickers quiet until bottom is on the seat.

Progressions and Intervention Ideas

Part Practice (only one phase of the transfer).

  • Preparatory phase: Work on good starting posture, activating back clicker to promote anterior pelvic tilt and increased weight bearing through the legs.
  • Transitional phase: Reach forward with arms and activate front clicker to promote anterior weight shift.
  • Transitional phase for stand to sit: partial squats to sit down keeping clickers quiet to improve the timing of weight shift and decrease a “plop”.

Symmetry of movement and weight-bearing

  • Does one side activate sooner than another or do you not activate one clicker on one side since you are weight bearing more on the opposite side.
  • Verbal cue: Hear the clicker go off at the same time standing up and sitting down.

Activate the vestibular system standing on foam footpads

  • Add head turns with sit to stand on foam

Changing the Stance Position

  • Staggered stance and step to work on step initiation.

Eyes closed to improve balance in dimly lit environments.

  • This is important when standing up from bed to walk in order to go to the bathroom at night. An article “Effect of Sitting Pause Times on Balance After Supine to Standing Transfer in Dim Light” mentions that the risk of falling for older adults increases in dimly lit environments.
  • The results of the study suggest that longer sitting pause times may improve adaptability to dimly lit environments, contributing to improved postural stability and reduced risk of fall in older adult women when getting out of bed at night.
  • This is an important topic on how the speed or timing to adapt in different environments (dim lit or uneven surfaces) can change our overall balance and postural control and should be integrated into balance exercises and goals.

Using multi-sensory feedback with the Balance Matters system will:

  • Improve an individual’s awareness of their starting posture and transitional postures.
  • The auditory feedback in the footpads helps promote improved timing, sequence of the task, weight distribution for symmetry and weight shift.

Remember, there are influential factors when designing programs using feedback. Fading the feedback for retention is highly recommended. In the Balance Matters courses, we review more in-depth these influential factors and clinical applications.

Originally printed on stepandconnect.com. Reprinted with permission.

Balance Matters is a unique balance training sensory tool developed by recognized Physical Therapist Erica Demarch, intended initially for Parkinson’s patients and others suffering from balance issues. Now has become a popular sensory balance training tool for people looking to “train their brain” for improved balance. The Balance Matters system is the foundation of Erica’s company, Step and Connect, stepandconnect.com.